A Simple Algorithm for Drain Management after Pancreaticoduodenectomy

2012 ◽  
Vol 78 (10) ◽  
pp. 1143-1146 ◽  
Author(s):  
Nicholas N. Nissen ◽  
Vijay G. Menon ◽  
Vichin Puri ◽  
Alagappan Annamalai ◽  
Brendan Boland
Keyword(s):  
Pancreatic Fistula ◽  
Temporal Pattern ◽  
Management Strategy ◽  
Simple Algorithm ◽  
International Study ◽  
Study Group ◽  
International Study Group ◽  
Drain Removal ◽  
Drain Amylase ◽  
Drain Management

Pancreatic fistula (PF) continues to be the Achilles’ heel of pancreaticoduodenectomy (PD) with both morbidity and mortality linked to its occurrence. The optimal drain management strategy after PD remains unclear. We evaluated drain amylase (DA) levels on postoperative Day (POD) 0 to 5 in 76 consecutive patients undergoing PD to determine the patterns associated with PF. Of these 76 patients, eight patients (11%) developed Grade A, B, or C PF by International Study Group of Pancreatic Fistula criteria. POD 1 DA levels correlated closely with PF rates when high (greater than 5000 U/L, 100% PF rate) and low (less than 100 U/L, 2% PF rate). In patients with intermediate POD 1 DA (100 to 5000 U/L), 42 and 74 per cent had low DA levels on POD 3 and 5, respectively, and the PF rate was four of 31 (13%). Overall, the temporal pattern of decreasing DA levels after PD correlates closely with the risk of PF, and only two patients (5%) developed PF after early DA levels had normalized. Based on these data, we propose an algorithm of monitoring DA daily with drain removal when the level is less than 100 U/L. In our patient group drain removal would have occurred on a mean of 1.8 days and median 1 day after surgery.

scholarly journals Use and acceptance of the International Study Group for Pancreatic Fistula (ISGPF) definition and criteria in the surgical literature

HPB ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Brian P. Chen ◽  
Sean Bennett ◽  
Kimberly A. Bertens ◽  
Fady K. Balaa ◽  
Guillaume Martel
Keyword(s):  
Pancreatic Fistula ◽  
International Study ◽  
Study Group ◽  
International Study Group

scholarly journals Clinical and Economic Validation of the International Study Group of Pancreatic Fistula (ISGPF) Classification Scheme

2007 ◽  
Vol 245 (3) ◽  
pp. 443-451 ◽  
Author(s):  
Wande B. Pratt ◽  
Shishir K. Maithel ◽  
Tsafrir Vanounou ◽  
Zhen S. Huang ◽  
Mark P. Callery ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Classification Scheme ◽  
International Study ◽  
Study Group ◽  
International Study Group

scholarly journals Use and acceptance of the international study group for pancreatic fistula (ISGPF) criteria in surgical literature

HPB ◽  
2017 ◽  
Vol 19 ◽  
pp. S100
Author(s):  
Brian P. Chen ◽  
Sean Bennett ◽  
Kimberly Bertens ◽  
Richard Mimeault ◽  
Fady K. Balaa ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
International Study ◽  
Study Group ◽  
International Study Group

Validation of Mucosal Sutureless Pancreatojejunostomy after Pancreatoduodenectomy

2014 ◽  
Vol 80 (2) ◽  
pp. 149-154 ◽  
Author(s):  
Yoichi Ishizaki ◽  
Jiro Yoshimoto ◽  
Hiroyuki Sugo ◽  
Hiroshi Imamura ◽  
Seiji Kawasaki
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Postoperative Mortality ◽  
International Study ◽  
Study Group ◽  
International Study Group ◽  
Duct Diameter ◽  
Pancreatic Duct Stenting ◽  
Clinically Significant ◽  
Low Rate

Although duct-to-mucosa pancreatojejunostomy has been considered safer than other techniques, this procedure is particularly difficult when the pancreatic duct is small. It has therefore become increasingly necessary to develop a simple mucosal sutureless pancreatojejunostomy technique to replace the conventional hand-sewing one. Two hundred fourteen patients who underwent mucosal sutureless pancreatojejunostomy were classified into two groups: those with a normal pancreatic duct diameter (less than 3 mm, n = 97) and those with a dilated pancreatic duct (3 mm or greater, n = 117). The rate of clinically significant pancreatic fistula (Grade B or C by the International Study Group on Pancreatic Fistula definition) among the patients as a whole was 8 per cent. The overall incidence of pancreatic fistula was significantly higher in the patients with a pancreatic duct diameter of less than 3 mm than in those with a pancreatic duct diameter of 3 mm or greater. However, the incidence of clinically significant pancreatic fistula did not differ between the groups (less than 3 mm, 11%; 3 mm or greater, 5%; P = 0.09). Grade C pancreatic fistula developed in one patient with a pancreatic duct diameter of less than 3 mm and in two with a pancreatic duct diameter 3 mm or greater. Although two patients required reoperation, all of the fistulas were cured and the postoperative mortality rate related to pancreatoduodenectomy was zero. Mucosal sutureless pancreatojejunostomy combined with pancreatic duct stenting is associated with a low rate of clinically significant pancreatic fistula even in patients with a small pancreatic duct diameter less than 3 mm.

International Study Group of Pancreatic Surgery Definitions for Postpancreatectomy Complications: Applicability at a High-Volume Center

2017 ◽  
Vol 106 (3) ◽  
pp. 216-223 ◽  
Author(s):  
N. Dusch ◽  
A. Lietzmann ◽  
F. Barthels ◽  
M. Niedergethmann ◽  
F. Rückert ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Pancreatic Surgery ◽  
Delayed Gastric Emptying ◽  
International Study ◽  
Postoperative Pancreatic Fistula ◽  
Study Group ◽  
Postpancreatectomy Hemorrhage ◽  
International Study Group

Introduction: The perioperative morbidity following pancreas surgery remains high due to various specific complications: postoperative pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying. The International Study Group of Pancreatic Surgery has defined these complications. The aim of this study is to evaluate the clinical applicability, to validate the International Study Group of Pancreatic Surgery definition, and to evaluate the postoperative morbidity. Methods: Between 2004 and 2014, 769 patients underwent resection. Data were collected in a prospective database. Univariate examination was performed using the χ2-test. Continuous data were tested with the Mann–Whitney U-test. Student’s t-tests and Fisher’s exact tests were performed. Results: A total of 542 patients were included in this study. In all, 91 (16.8%) patients developed postoperative pancreatic fistula, 69 of them clinically relevant grades B and C postoperative pancreatic fistula. Grades B and C postoperative pancreatic fistulas were significantly associated with a longer hospital stay. The postoperative pancreatic fistula grade significantly correlated with re-operation. Totally, 32 (5.9%) patients developed postpancreatectomy hemorrhage. Postpancreatectomy hemorrhage grade was significantly associated with re-operation and 30-day mortality. In all, 14 of 19 patients with grade C postpancreatectomy hemorrhage (73.7%) were re-operated; 3 had a simultaneous postoperative pancreatic fistula C. Grade B postpancreatectomy hemorrhage significantly prolonged hospital stay. Grade C postpancreatectomy hemorrhage significantly prolonged intensive care unit stay. Grade C postpancreatectomy hemorrhage led to longer intensive care unit stay but a shorter hospital stay. Delayed gastric emptying occurred in 131 (24.2%) patients. The delayed gastric emptying grade was significantly associated with re-operation. Nine of the re-operated patients had a simultaneous postoperative pancreatic fistula C. Grades A, B, and C delayed gastric emptying were associated with prolonged hospital- and intensive care unit stay. Conclusion: Delayed gastric emptying is the most common specific complication after pancreas resection, followed by postoperative pancreatic fistula and postpancreatectomy hemorrhage. The International Study Group of Pancreatic Surgery definitions are well applicable in clinical routine and the different grades correlate well with severity of clinical condition, length of hospital or intensive care unit stay, and mortality. Their widespread use can contribute to a more reproducible and reliable comparison of surgical outcomes in pancreas surgery.

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